| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 Filed as: USI SOUTHWEST, INC. | PO BOX 203066 DALLAS, TX 75320 | LIBERTY LIFE ASSURANCE COMPANY OF BOSTON | $22K | $12K | $34K | 6.24% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62817 VIRGINIA BEACH, VA 23466 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $3K | $0 | $3K | 4.70% |
| MARC A GROVE3 Filed as: MARC A. GROVE | 25900 AUTUMN WAY ROGERS, MN 55374 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1K | $652 | $2K | 2.80% |
| ELIZABETH MARIE LANGEVIN3 Filed as: ELIZABETH M. LANGEVIN AND AGENTS | 698 WEST LARPENTEUR AVENUE SAINT PAUL, MN 55113 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2K | $223 | $2K | 2.79% |
| WORLD INSURANCE ASSOCIATES LLC3 Filed as: KLH INSURANCE, INC. | 3357 POLK STREET NE MINNEAPOLIS, MN 55418 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1K | $238 | $2K | 2.10% |
| EMPLOYEE BENEFIT ADVANTAGES INC3 Filed as: EMPLOYEE BENEFIT ADVANTAGES, INC. | 14740 BOWERS DRIVE NW RAMSEY, MN 55303 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $893 | $0 | $893 | 1.23% |
| MEGHAN MOFFATT LUCAS3 | 2650 ACORN RUN VICTORIA, MN 55386 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $384 | $128 | $512 | 0.71% |
| JILL R LAMBERT3 Filed as: JILL R. LAMBERT | 12741 JEFFERSON STREET NE BLAINE, MN 55434 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $324 | $59 | $383 | 0.53% |
| STEVEN BAKER4 | 153 ESTHER DRIVE COCOA BEACH, FL 32931 | PRE-PAID LEGAL SERVICES, INC., DBA LEGALSHIELD | $3K | $0 | $3K | 29.84% |
| USI INSURANCE SERVICES LLC4 Filed as: USI INSURANCE SERVICES, INC. | 8331 NORMAN CENTER DRIVE, SUITE 500 BLOOMINGTON, MN 55413 | PRE-PAID LEGAL SERVICES, INC., DBA LEGALSHIELD | $332 | $0 | $332 | 2.90% |
No Schedule C service providers reported on this filing.
Benefits declared on the Form 5500 main form (✓ = also has a Schedule A insurance contract; otherwise the benefit is funded out of plan assets or via a Schedule C TPA).
The plan reports several different headcounts depending on which form you read. Each one measures a different slice of the population.
| Active participants | 1,227 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 1,227 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Vision | EYEMED VISION CARE ON BEHALF OF FIDELITY SECURITY LIFE INSURANCE CO. | 1,000 | $78K |
| Life insurance | LIBERTY LIFE ASSURANCE COMPANY OF BOSTON | 1,212 | $552K |
| Short-term disability | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 160 | $72K |
| Long-term disability | LIBERTY LIFE ASSURANCE COMPANY OF BOSTON | 1,212 | $552K |
| Other(4 contracts, 4 carriers) | LIBERTY LIFE ASSURANCE COMPANY OF BOSTON | 1,227 | $589K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,227 | — |
Why the numbers differ. Form 5500 line 6 counts employees + retirees + beneficiaries; no dependents. Schedule A persons-covered counts everyone enrolled, including spouses and children, so it usually exceeds line 6 by 30-60% on a working-age workforce. The medical row is normally the broadest single line because it has the highest take-up; dental/vision/life often dip below it. Stop-loss / reinsurance contracts sometimes report the carrier's full underwriting pool rather than this filer's headcount; the row is shown for transparency but shouldn't be read as "people in this plan."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.